The safety of implanting sustained release 5-fluorouracil during operation in patients with thoracic neoplasms
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Objective To investigate the safety of implanting sustained release 5-fluorouracil during operation for patients with tumor of the chest.Methods Eighty patients from January 8 to June 10 in 2008 were selected.Sustained release 5-fluorouracil was implanted in 40 cases with tumor of the chest during operation.Forty patients as control group underwent operation alone.The indexes of routine examination pre-and post-operation such as blood indexes,the function of heart,lung,liver and kidney,and the incidence of complications were compared.Results There were no significant differences of blood indexes and the function of heart,lung,liver and kidney between the two groups.There was more fluid drained in the group of sustained release 5-fluorouracil.Differences in other indexes were not found between the two groups.Conclusion Implanting sustained release 5-fluorouracil during operation is a safe and simple therapy with few side effects.Cite
Gastroduodenal artery
Liver function
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Objective To observe the efficacy of endoscopic implantation of slow-releasing 5-fluorouracil(5-FU) in relieving incomplete gastric outflow obstruction due to locally-advanced carcinoma.Methods A total of 12 advanced gastric cancer patients enrolled into this study.During the endoscopy procedure,slow-releasing 5-FU agent was implanted compactly into the infiltrated tumor lesion.Forty-five to sixty pieces of agent(each piece equivalent to 1.67 mg 5-FU) were deployed,with an average dose of 90 mg.Simultaneously,3 mg lentinan was injected surround the infiltrated lesions.Results Sixteen procedures of slow-releasing 5-FU implantation were performed.No hemorrhage or perforation was observed.Parameters of hepato-renal function and complete blood count were stable after implantation.The numbers of patients with satisfactory,very good and good results in relieving symptom were 3,4 and 3 respectively,with an overall response rate of 83.3%(10/12).The average time of sustained symptom-relieving was 22 d.Two patients were transferred to gastrectomy after pertinent symptoms relievement following slow-releasing 5-FU implantation.Conclusions The time of sustained obstructive symptom-relieving after slow-releasing 5-FU implantation ranges from 15 to 30 d,much longer than that of conventional chemotherapy via either intravenous or locally applied water-soluble agents.Satisfied results have been observed in relieving incomplete gastric outflow obstruction due to tumor infiltration,and improving the performance status of patients.
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Liver metastases are a common cause of death in colon carcinoma. The dual blood supply of the liver permits regional perfusion while hepatic catabolism of 5-fluorouracil (FU), floxuridine (FUdR) permit higher drug exposures than systemic (IV) administration. We have studied the effect of continuous intraarterial chemotherapy (FU: 5–10 mg/kg/day and FUdR: 0.2 mg/kg/day) and whole liver irradiation (1000 rad every 4 weeks, total dose of 3000 rad) for metastatic colon carcinoma to liver. Eighteen patients with metastases to liver only are reported using this combination therapy. Seven patients had percutaneous placement of a catheter via the brachial artery, two had operative placement of a catheter via the gastroduodenal artery, all of which were connected to the Cormed infusor system, nine had operative placement of the Infusaid implantable pump with catheter placement into the hepatic artery via the gastroduodenal artery. The median survival for the entire group was 241 days. In those patients whose liver function tests (bilirubin and alkaline phosphatase) were less than two times normal, the median survival was 770 days. The median survival of the patients with greater than two times normal LFT's was 178 days. Two patients died of complications of the treatment. One who developed irreversible radiation hepatitis but at autopsy had only two areas of microscopic tumor foci in the liver and another who had received only 15 days of infusion and 1000 rad to liver. This patient developed irreversible chemical enteritis secondary to chemotherapy infusion into the superior mesenteric artery. Three patients have undergone abdominal reexploration and one at autopsy, who were found to have no gross evidence of tumor in the liver despite previous pathologic confirmation. It appears that some patients with minimal tumor burdens can have sterilization of their tumors. There were three cases of reversible liver function abnormalities. Complications associated with conventional intra-arterial chemotherapy (artery thrombosis, catheter sepsis and dislodgement, pump infusion variation and pump failure) were not seen with the Infusaid delivery system. The pump is refilled every 2–3 weeks via percutaneous puncture. All therapy was given on an outpatient basis. Pump acceptance and tolerance was 100%. Intra-arterial chemotherapy can now be accomplished without the morbidity associated with it in the past. The combination of chemotherapy and liver irradiation may offer improved survival in selected patients.
Gastroduodenal artery
Floxuridine
Celiac artery
Common hepatic artery
Liver function
Elevated alkaline phosphatase
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Vascular surgery
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Continuous chemotherapy for hepatic metastases secondary to carcinoma of the colon and/or rectum was delivered via implantable pump in 20 patients. This is a follow-up to a preliminary report published in January 1985. Pumps were placed by a single surgeon in a community hospital; there was no mortality and minimal morbidity. Follow-up of these patients revealed a significant long-term complication rate secondary to effects of chemotherapy. Nine patients were alive at the cutoff date of this report; mean follow-up was 16 months. Eleven patients have died following implantation, with a mean survival of 14 months. Statistical analyses demonstrated increased survival rates for those patients whose tumors were poorly differentiated when compared with those with moderately differentiated or well-differentiated tumors. The objective response of liver metastases was overwhelmingly positive, as judged by CT scan and serial CEA levels. The significant rehospitalization rate for complications and the marginal increase in survival, however, have discouraged implantation of the pump at our institution.
Surgical oncology
Colorectal Surgery
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We clinically examined 56 patients with metastatic liver cancer who received hepatic arterial infusion chemotherapy via a reservoir at the Department of Surgery, Public Fujioka General Hospital between January 1989 and March 1999. There were 28 males and 28 females. Patient ages ranged from 40 to 83 years, with a mean of 64.1 years. Primary cancers consisted of colorectal cancer in 34 patients, gastric cancer in 8 patients, gallbladder cancer in 4 patients, breast cancer in 4 patients, leiomyosarcoma in 2 patients, pancreatic cancer in 1 patient, bile duct cancer in 1 patient, ampullary carcinoma in 1 patient and ovarian cancer in 1 patient. Thirty-one patients had simultaneous lesions, while 25 patients had metachronal lesions. A catheter was inserted under laparotomy in 25 patients. A catheter was percutaneously inserted through the femoral artery in 31 patients. Agents included 5-fluorouracil (5-FU), epirubicin hydrochloride (EPI) and mitomycin-C (MMC). There were no serious complications.In 42 patients who received hepatic arterial infusion chemotherapy excluding patients who underwent surgery for metastatic liver cancer and patients who died of other diseases, the mean survival was 421.1 days. When response was evaluated, complete response (CR) was achieved in 3 patients, partial response (PR) in 12 patients, no change (NC) in 11 patients and progressive disease (PD) in 16 patients. The response rate was 35.7%. One-year, 2-year and 3-year cumulative survival rates were 59%, 23% and 8%, respectively. These percentages in the hepatic arterial infusion chemotherapy group were higher than cumulative survival rates in the systemic chemotherapy group and the untreated group. Therefore, hepatic arterial infusion chemotherapy may prolong survival.
Epirubicin
Gallbladder Cancer
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From 1976 to 1988, hepatic arterial infusion chemotherapy was performed in 52 patients with unresectable hepato-cellular carcinomas. Forty-nine (94%) out of 52 patients were stage III or stage IV. Thirty-five patients underwent continuous infusion of 5-FU and MMC employing chronometric infusion pumps. Mean survival of this group was 9 months. Six patients survived more than 12 months; the longest survivor died of different causes 40 months after surgery. Another patient lived for 30 months. In 10 patients, hepatic arterial ligation was performed in combination with infusion chemotherapy in the hepatic artery. Mean survival of these patients was 14 months. Four out of the 10 patients survived over 12 months. Recently, in 7 patients whose liver tumors were less than 4 cm in diameter and/or whose tumors were multiple and had liver disfunction, ethanol injection into the tumors during laparotomy was performed in combination with hepatic arterial infusion chemotherapy. In these 7 patients, an injection port system was implanted subcutaneously for intermittent infusion chemotherapy of MMC + 5-FU and ADM + lipiodol. Mean survival in this group was 14 months. One of 7 patients died 21 months after operation, but the others are alive at this writing. Five of these 6 patients have survived more than 12 months. AFP levels decreased in 3 patients after these treatments. In one case, AFP decreased to normal range for 18 months. These results suggested that intraoperative ethanol injection therapy into the tumors combining with hepatic arterial infusion chemotherapy may be of value for unresectable smaller liver carcinomas, since this method is technically easy and can assure injection of ethanol into the tumors during laparotomy.
Lipiodol
Common hepatic artery
Hepatic arterial infusion
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Background: It has recently been demonstrated that the liver parenchyma is more tolerant to intermittent pedicular clamping than to continuous pedicular clamping.However, the possibility of increased blood loss during intermittent reperfusion is a major concern.Design: We retrospectively selected 34 cases in which the cumulative clamping time was 90 minutes or longer during hepatectomy and the intermittent Pringle maneuver was applied rather than continuous inflow occlusion.
Hepatolithiasis
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A 42-year-old female was diagnosed as having sigmoid colonic carcinoma with multiple metastases in the liver. Following sigmoid colectomy and descending colostomy, a catheter was inserted from the right gastroepiploic artery to the proper hepatic artery. From the day of surgery 5-Fluorouracil was administered in doses of 250 mg/day continuously through a catheter over the 2-month period of hospitalization. After the patient was discharged, 250 mg/day of 5-Fluorouracil was administered at home using Vaxter Infusor according to a regimen of 10-day continuous infusion and subsequent 4-day rest. Five months after the initial operation, the serum CEA level decreased dramatically, and CT scan of the liver revealed the complete disappearance of the metastases. The patient underwent a second operation in which the colostomy was closed, and she is doing well at this writing. This case suggests that long-term, ambulatory, continuous and intra-hepatic-arterial infusion of 5-Fluorouracil can be a very effective treatment not only in reducing the hepatic metastases but also in improving the quality of life of patients with colonic carcinoma.
Continuous Infusion
Right gastroepiploic artery
Regimen
Infusion pump
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Objective To analyze the curative effect and side effect for the patient who sufered liver metastasis after rectal carcinoma operation treated with interventional arterial perfusion and embolism contained oxaliplatin,pirarubicin and lipiodol.Methods 48 cases of such patient from January 2004 to April 2007 were treated with this method and patients were followed up 1 month.The short term effect and side effect were assessed.Results The total effective rate was 66.7% with partial relief.The common side effects were gastric reaction(nausea and vomiting)(72.9%),then bone marrow inhibition(47.9%) and liver injury(45.8%) those were recovered in short time.Conclusion This method might be one of the safe and effective way for these patient.
Lipiodol
Pirarubicin
Bone marrow suppression
Arterial perfusion
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